老年医院获得性肺炎患者临床特征及死亡危险因素分析  

An analysis of clinical characteristics and risk factors for mortality in elderly patients with hospital⁃acquired pneumonia

作　　者：吴文斌[1] 杨海玲[1] 朱家馨[1] 郑文争[1] 冯定云[1] 张天托[1] WU Wenbin;YANG Hailing;ZHU Jiaxin;ZHENG Wenzheng;FENG Dingyun;ZHANG Tiantuo(Department of Pulmonary and Critical Care Medicine,the Third Affiliated Hospital,Sun Yat-sen University,Guang-zhou 510630,China)

机构地区：[1]中山大学附属第三医院呼吸与危重症医学科,广州510630

出　　处：《实用医学杂志》2020年第24期3425-3429,共5页The Journal of Practical Medicine

基　　金：广东省医学科研基金项目(编号:A2019062)。

摘　　要：目的通过分析老年医院获得性肺炎(hospital acquired pneumonia,HAP)患者临床特征及死亡危险因素等,为临床早期干预、早期决策提供依据,以改善预后,降低病死率。方法纳入我院自2014年1月1日至2018年1月1日诊断的老年HAP患者病例,回顾性分析其病历资料,并将其分为生存组和死亡组,分析其临床特征及死亡相关危险因素等。结果497例HAP患者入组,50%~60%有发热、咳嗽、咳脓痰症状,9.7%有呼吸困难症状,常合并脑血管病、糖尿病等,血尿素氮/白蛋白平均比值为(0.224±0.157)mmol/g,21.5%存在多重耐药菌感染,48.9%有发病前90 d内使用抗生素史。死亡例数为76例(15.3%)。经Cox回归分析发现,有咳脓痰、呼吸困难症状、发病前90 d使用抗生素史、既往有放化疗病史、多重耐药菌感染、血尿素氮/白蛋白水平升高是老年HAP患者死亡的相关危险因素。血尿素氮/白蛋白水平的ROC曲线下面积为0.703。高血尿素氮/白蛋白比值的HAP生存期明显低于对照组。结论老年HAP症状不典型,合并症多,常存在多重耐药菌感染,且病死率高。血尿素氮/白蛋白比值是HAP患者死亡的独立危险因素,值得临床医生重视。Objective Hospital acquired pneumonia(HAP)is one of the most common nosocomial infec⁃tions and often causes prolonged hospital stay and increased mortality.The elderly population is a high proportion of HAP,which needs more attention from clinicians.The purpose of this study is to analyze the clinical characteristics and risk factors of elderly HAP,in order to provide evidence for early clinical intervention and decision making,to improve prognosis and reduce mortality.Methods The patients with HAP diagnosed in our hospital from January 1,2014 to January 1,2018 were included,and their medical records were retrospectively analyzed.The patients were divided into a survival group and a death group,and their clinical characteristics and death⁃related risk factors were analyzed.Results Of 497 enrolled patients with HAP,50%~60%had symptoms of fever,cough and purulent sputum,9.7%had dyspnea symptom and often accompanied by cerebrovascular disease and diabetes.The average blood urea nitrogen/albumin ratio was(0.224±0.157)mmol/g,21.5%had multidrug⁃resistant bacterial infection,and 48.9%had a history of antibiotic use within 90 days before onset.The death toll was 76(15.3%).According to COX regression analysis,purulent sputum,dyspnea,history of antibiotic use 90 days before onset,history of chemoradiotherapy,multidrug⁃resistant bacterial infection,and increased blood urea nitrogen/albumin levels were the risk factors for death of elderly patients with HAP.The area under the ROC curve of blood urea nitrogen/albumin level was 0.703.The survival time of HAP with high blood urea nitrogen/albumin ratio was signifi⁃cantly lower than that of the control group.Conclusions Symptoms were atypical in the elderly patients with HAP,who had many complications,multiple drug⁃resistant bacteria infection and high mortality.Blood urea nitrogen/albumin ratio is a simple and valuable risk factor for death,which deserves clinicians′attention.

关 键 词：医院获得性肺炎 老年人 临床特征 危险因素 

分 类 号：R563.1[医药卫生—呼吸系统]